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Medicare Advantage Plans

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What is a Medicare Advantage Plan?

A Medicare Advantage plan is also referred to as Part C of Medicare.  Medicare Advantage is an alternate way of receiving your Medicare benefits. Medicare Advantage plans are a direct replacement of Original Medicare.  This type of coverage started off strong a few years ago, but has seen major regulation and has had some serious negative public and federal impacts in the past few years.   If you elect to enroll in a Medicare Advantage plan, you will no longer be receiving Medicare Part A & B coverage thru Original Medicare, but thru the insurance company offering the Advantage plan you signed up for.  You will be locked into the rules and regulations that the insurance company who offers the plan, has set forth.  Medicare Advantage plans come in different types of policies including HMO (Health Maintenance Organization), PPO (Preferred Provider Organization, or a PFFS (Private Fee For Service).  


These types of policies require you to only use specific doctors and hospitals that are in a certain network.  There are also some pretty hefty deductibles for hospitalization.  It’s not uncommon to see $200 - $250 deductible per night for hospital stays.  Many times you may hear how “cheap” these policies are, but the coverage on this type of plan is significantly below most people’s “comfort” zone.

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How do Advantage Plans work?

Basically, Advantage plans are privatized Medicare benefits, offered by a private insurance company.  They are funded by financial assistance from the government.  Medicare Advantage plans have a contract with Medicare to administer your benefits and for that Medicare pays an average of $600 - $800 per month to the Medicare Advantage company, if you enroll in an Advantage plan,  instead of keeping  your original Medicare.  These companies must follow the rules set by Medicare, but they can charge different “out-of-pocket” cost and have different rules for how you get your services.  Some Advantage plans will require you to have a referral to see a specialist while others will require you to go to specific doctors, hospitals, or suppliers that belong to the plan.  These rules can change each year.  The doctor or facility you go to, must agree to accept assignment of your plan. Not every doctor or hospital that accepts Medicare, will accept an Advantage plan.  If you go to a doctor or hospital that does not accept your plan, you are responsible for the entire bill.  Medicare will not pay anything.

Is an Advantage Plan right for you?

Medicare Advantage plans normally include Part D (Prescription Drug Coverage) in their plans.  Some of these plans have very low premiums, making them attractive to many people.  With the  significant co-pays, deductibles, coinsurance, and out-of-pocket expenses that you see with the Medicare Advantage plans, most people find it extremely  difficult to budget such an unpredictable cost, especially when their out-of-pocket can be $3000 - $5000+ a year.  If you are on a fixed income, this could almost be impossible to pay.  The reality with Medicare Advantage plans is  that even though the cost may be very little, the unexpected can be devastating.

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What is Medicare Part C?

Medicare Part C is the same as Medicare Advantage Plans.  Basically Part C of Medicare gives you an alternative way to receive your Medicare Benefits, thru a Medicare Advantage Plan.  A Medicare Advantage Plan completely replaces your government Original Medicare Benefits.  Basically, Advantage plans are privatized Medicare benefits, offered by a private insurance company.  They are funded by financial assistance from the government.  Medicare Advantage plans have a contract with Medicare to administer your benefits and for that Medicare pays an average of $600 - $800 per month to the Medicare Advantage company, if you enroll in an Advantage plan,  instead of keeping  your original Medicare.  These companies must follow the rules set by Medicare, but they can charge different “out-of-pocket” cost and have different rules for how you get your services.  To learn more about Medicare Advantage plans go to Medicare Advantage Plans

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